Protecting Your Health in Erie, PA | Erie County Medical Society

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.

About 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. Breast cancer accounts for 29% of all cancers in women; it is second only to lung cancer as a cause of cancer death among women.

In 2018, an estimated 266,000 new cases of invasive breast cancer are expected to be diagnosed in US women in the U.S., along with 63,960 new cases of non-invasive (in situ) breast cancer.

Although the overall US incidence of breast cancer is higher in white women, a larger proportion of African-American women are diagnosed with larger, advanced-stage tumors. In 2015, breast cancer death rates were 39% higher in African-American women than in white women.

Risk Factors

Increased age is a predominant risk factor in breast cancer. The disease is 7 times more likely in women over 50 than in those under 50. Nevertheless, when breast cancer occurs in younger women, it tends to behave more aggressively.

The incidence rate of breast cancer increases with age, from 1.5 cases per 100,000 in women 20-24 years of age to a peak of 421.3 cases per 100,000 in women 75-79 years of age

Family history is a further risk factor. The risk is 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is even greater if the relative was less than 50 years old when diagnosed with breast cancer. Further, ovarian cancer is also a consideration. Ovarian cancer in a first-degree relative doubles the risk of breast cancer.

Current oral contraceptive use seems to increase the risk of breast cancer by about 25%. To put this in perspective, it means that a hypothetical risk would rise from 20 in 10,000 to 25 in 10,000. However, risk returns to that of the average population within about 10 years following cessation of oral contraceptive use.

Increased risk of breast cancer in postmenopausal women has been associated with the following:

Adult weight gain of 45 pounds above body weight at age

Diet high in animal fats and refined carbohydrates

Sedentary lifestyle

Consumption of 3-5 alcoholic beverages per week

Finally, increased risk of breast cancer has been associated with first pregnancy at a later age, early onset of menses, and late age of menopause.

On the brighter side, close adherence to a Mediterranean diet is associated with lower risk for breast cancer, especially for types that carry a poorer prognosis in postmenopausal women.

Types

Contrary to popular belief, breast cancer is not a single entity. There are almost a dozen different types of breast cancer. Two of these, infiltrating ductal carcinoma and infiltrating lobular carcinoma, account for almost 90% of cases. The different types of breast cancer are typically identified when the pathologist views the tissue specimens under a microscope. Some types behave much more aggressively than others.

Even within these types, there are certain characteristics that can make some cases behave differently from others. These individual characteristics may make some tumors more susceptible than others to certain treatments.

Signs and symptoms

Early breast cancers usually have no symptoms. Later breast cancers may show

Only 5% of patients first consult their doctor because of breast pain or discomfort.

Screening

Because of the absence of early signs and symptoms, screening plays an important role in early detection. Some evidence exists that, at 14 years follow-up, screening mammography reduces breast cancer deaths by about 20–35% in women 50–69 years old and slightly less in women 40–49 years old.

Mammography often detects a lesion 1 to 2 years before noted by breast self-examination. Nevertheless, partly due to lack of health insurance, 20-30% of women still do not undergo screening as indicated.

Debate continues among authorities regarding the appropriate interval between mammographic screenings, the age at which screenings should begin, and the age at which they are no longer necessary. However, there seems to be general agreement that annual mammography is more appropriate to younger women, that biennial mammography is more appropriate to slightly older women, and that screening mammography is not appropriate for women with a limited life expectancy. For specifics about ages and frequency intervals, each woman is referred to her own physician.

Treatment

Each case is different and the most aggressive treatments are not always necessary. Sometimes breast-conserving surgery suffices. Sometimes only partial breast irradiation at the tumor-removal site is appropriate. Sometimes chemotherapy is not required. No one should delay or avoid seeing their physician because of assumptions about treatment.

Conclusion

In brief, breast cancer remains a major death threat to women. There are several types of breast cancer, each behaving with its own degree of aggressiveness. Screening is important since early breast cancers show minimal symptoms. Each woman is referred to her own physician regarding screening specifics. Since each case is different, the most aggressive treatments are not always necessary. No one should delay or avoid seeing a physician due to false assumptions about treatment.